Peter Dixon, M.D., Director of Ambulatory Care Programs and General Pediatrics for the Pediatric Service at Massachusetts Bay Hospital (MassBay), and Linda Leone, Administrative Director at MassBay Pediatrics, met over coffee on a bleak Monday morning in March to discuss plans for the renovation of the Pediatric Service space. They agreed that renovated space was a high priority for the Service, but both felt that the new unit offered an even greater challenge. Peter said,
We have a real opportunity here to consider major changes in the way we operate. Now is a good time to think about centralizing some of the services we've run as separate operations. I think we could see some significant improvements in patient flow - and we'll probably also see some cost savings from economies of scale.
I think so, too, but I'm concerned about some of the tradeoffs. We might find that we'd lose the personal feeling we have now. Patients and their parents all know the staff for each specialty and that's important. But you're right. With all the pressure for cost control, we have to come up with a practice design that will be as cost efficient as possible.
They agreed that any designs they considered for the new practice operation would need to be both cost efficient and satisfying to patients æ and that the first step was to collect some data on the current operation.
Pediatric Service Operations
In March 1996, the Pediatric Service operated several small, contiguous ambulatory care practices which shared examining room space, supplies and conference areas but which otherwise generally maintained separate support staffs with cost centers and budgets. The current eight full-time equivalent (FTE) support staff were responsible for both front-office functions (face-to-face tasks such as check-in and check-out) and back-office functions (telephone and billing tasks); transcription was performed by an additional FTE employee (Exhibit 1).
The primary care service was called the Pediatric Group Practice; specialty services comprised a number of medical specialties. Some of the practices had relatively small volumes (Exhibit 2) and did not provide daily clinical services. Across the practices, service models varied widely and standard visit lengths for each practice differed significantly (Exhibit 3). Practice style also varied from service to service; some offered fairly sophisticated nursing services while others offered no nursing services at all. When staff were shared, budget allocations were made based on the . . .
- What factors should be considered in forecasting future demand for the Pediatric Group Practice?
- What factors should be considered when determining exam room requirements? How many rooms are needed to accommodate a doubling of Pediatric Group Practice patient volume?
- Evaluate the current process flow. What recommendations would you make? How does the physical layout of the unit affect the flow?
- What are the advantages and disadvantages of the different scheduling methods being considered by the Pediatric Group Practice? Which would you advocate?
- Evaluate the proposed redesign of the support staff function. What changes, if any, would you suggest?